Midface Lift

The midface lift is a surgical procedure that involves elevation of the cheek, or midface, with no visible external incisions. It is commonly performed in conjunction with a more traditional facelift or other facial rejuvenation surgery, though it can certainly be a stand-alone procedure. The midface lift, when applied to the right surgical candidates, provides extremely natural looking and rejuvenating results.

With aging, the general shape of the face transforms from a youthful heart shape to a more rectangular shape. The descent of the cheek, combined with formation of the jowls and generalized loss of volume in the upper and middle portions of the face all contribute to this process. Traditional facelift techniques, wonderful for improvement of the jawline, neck, and jowls, are therefore well complemented by the midface lift.

The procedure is performed with two small incisions in the hairline and two additional small incisions at the gingivolabial sulcus (where the gums meet the inside of the upper lip). Dr. Mehta utilizes a dissolvable device, the Endotine Midface™ ST (Coapt Systems, Inc.), to secure the cheek in the raised position.

A talented facial plastic and reconstructive surgeon, Dr. Mehta has many satisfied midfacial rejuvenation patients with excellent results.

The Consultation

Your visit for a midface lift consultation with Dr. Mehta will last approximately one hour. Dr. Mehta will begin by asking you what exactly bothers you about your appearance and what improvements you would like to achieve. Nonsurgical options for midface improvement include fillers such as Juvederm Ultra, Juvederm Ultra Plus, Restylane, Perlane, Radiesse, and Sculptra. Fat transfer can also be quite effective. If you are a candidate for any of these treatments in lieu of or in addition to the midface lift, he will discuss these with you in detail.

Dr. Mehta will then obtain a careful history, including medical conditions that may affect your ability to undergo and recover from surgery. Any history of adverse reactions to anesthesia or medications commonly given before, during, and after surgery is also determined.

This discussion is followed by a thorough examination of your face and neck, followed by a demonstration in front of a mirror of the effect of elevating your midface. Following the examination, Dr. Mehta will photograph your face from several different angles. The images are displayed on his computer, at which time Dr. Mehta will “morph” your image, illustrating the effects of the midface lift.

After your consultation, Jill, our Office Coordinator, will assist you with scheduling your surgery, pre- and postoperative appointments and schedule a second consultation for you, should you so desire.

Preoperative Visit

After this initial consultation, you would return for a preoperative visit, two or three weeks before your surgery. At this visit, Dr. Mehta will again go over your list of medications and supplements, as it is usually necessary at this time to discontinue any products that can increase the risk of bleeding during or after the surgery. These include, but are not limited to, aspirin, ibuprofen, heparin, warfarin (Coumadin), Plavix, vitamin E, fish oil and numerous other supplements. The decision to stop any of these prescription or over-the-counter products is made in conjunction with your primary physician. Medical clearance and other tests may need to be obtained, depending on your age.

Dr. Mehta will give you prescriptions for your pain medication and antibiotic (or call your pharmacy) at this visit as well. This allows you to pick up these important medications prior to your surgery, so that postoperatively, you and your caretakers can rest and concentrate on your recovery. Dr. Mehta will advise you to pick up Arnica Montana and Bromelain, two homeopathic products which reduce bruising after surgery. These are taken as directed, beginning immediately after surgery. You will be given detailed preoperative and postoperative instruction pamphlets, to read prior to your surgery. It is important to minimize salt intake and avoid alcohol for three days leading up to your surgery.

Lastly, you will have the opportunity to spend time with the office coordinator, to answer any logistical questions related to your surgery. Your final surgical fees are settled at this visit as well.

Surgery

On the day of surgery, you will arrive at the surgical center with a friend or family member who will drive you home and care for you after your surgery. It is imperative to come in on an empty stomach, not eating or drinking anything for at least 8 hours prior to your surgery. This includes water and chewing gum. You should wear loose, comfortable clothing, including a shirt that buttons in the front to avoid having to pull anything over your head after surgery.

The operating room nurse will meet with you first to go over your instructions in detail. You will then meet your anesthesiologist, who will have carefully reviewed your medical and surgical history. You will have the opportunity to ask the anesthesiologist any questions you may have at this time. Finally, Dr. Mehta will meet you and your friends/family to answer any last minute questions as well.

For the majority of his midface lift surgeries, Dr. Mehta and the team of anesthesiologists use “twilight” sedation, in which the patient is completely unconscious but breathing on his or her own throughout the surgery. This prevents the need for placement of a breathing tube, paralysis or use of a ventilator. Additionally, patients awaken more quickly after the surgery and have less nausea and “hangover” effect.

After surgery, you will awaken in the recovery room, where your vital signs are carefully monitored by the anesthesiologist and recovery room nurse.

After Surgery

After approximately two hours in the recovery room, you will be discharged home, in the care of a responsible adult for the first night. Your friend or family member will check your incisions, ice your face, assist with your pain medications, and help you with your normal daily activities. You will sleep with your head elevated at 30-45 degrees. At this time, you will begin taking your prescribed medications as well as the Arnica Montana and bromelain. Eating fruits such as pineapple and papaya are encouraged as well, as they are thought to help minimize bruising.

You will return to the office the following morning to be seen by Dr. Mehta. He will check your incisions and go over your instructions in detail. Over the next 48-72 hours most patients develop bruising around the eyes and cheeks, though pain and discomfort are usually mild to moderate. Patients are up and about that same evening after surgery and generally the recovery is quite easy. Patients may work from home as early as 2 days after the surgery, though most wait around 8-10 days before heading out in public.

Your diet should be soft, mild in flavor and with minimal salt for the first 10-14 days after surgery. To minimize swelling and the risk of complications, you should avoid any vigorous activity or heavy lifting for this same period of time.

Your next visit will be 6-7 days after surgery, at which time your sutures or staples from your scalp incisions are removed. The sutures inside your upper lip are dissolvable and therefore typically do not require removal. Your face will be somewhat swollen and bruised at this time, though the majority of the swelling and bruising disappears over the subsequent 4-5 days. On average, patients return to work or school at 10-14 days after surgery though this certainly varies depending on one’s degree of bruising/swelling and comfort level.

The next visit will be at 3 weeks after surgery, at which time, Dr. Mehta will check your progress and answer any questions you may have. Your next visit will be at 6 weeks, followed by 3 months, at which time the first “after” photographs are often taken. Subsequent visits are every 3 months or so.

Conclusion

The midface lift can yield natural appearing rejuvenating results by elevating the cheek to its original position. The surgery is well tolerated by most patients and has a brief recovery period afterwards. It is an important and often undertreated area in facial rejuvenation and can complement other procedures quite well.

If you have questions or would like to schedule a consultation, please feel free to contact our office.

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